A group of nurse managers is discussing cost effectiveness with hospital administrators. Which of the following statements indicates a strategy for cost effectiveness?

Rationale:

• Encourage the client to discuss their feelings: Encouraging emotional expression is a key therapeutic approach in managing bulimia nervosa. It allows the client to explore underlying psychological issues, such as anxiety and fear of weight gain, which often contribute to disordered eating behaviors.
• Provide a reduced sodium diet: Sodium restriction is not indicated in this client. In fact, the client has a slightly low sodium level (134 mEq/L), and further restriction could worsen electrolyte imbalances, which are already contributing to cardiac instability.
• Request a prescription for fluoxetine: Fluoxetine, an SSRI, is approved for the treatment of bulimia nervosa and can reduce the frequency of binge-purge episodes. It is also effective in treating coexisting anxiety or depressive symptoms, which are common in this population.
• Request a prescription for bupropion: Bupropion is contraindicated in clients with eating disorders due to its seizure risk. In clients with bulimia, frequent vomiting and low electrolytes increase this risk significantly, making bupropion an inappropriate choice.
• Monitor daily intake and output: Monitoring intake and output helps evaluate hydration status and kidney function, both of which may be compromised due to chronic purging. It also helps track nutritional rehabilitation and prevent complications from electrolyte shifts.

Rationale:

A. Drop the sterile gauze from 25.4 cm (10 in) above the sterile field: Dropping sterile items from a height of about 6 to 12 inches prevents contamination by keeping hands outside the sterile field and ensuring the item lands safely without touching nonsterile surfaces.

B. Hold the sterile package in his dominant hand and open the top flap of the package toward his body: The top flap should be opened away from the nurse’s body to maintain sterility and prevent the arm from crossing over the sterile field, which would risk contamination.

C. Place objects 1.27 cm (0.5 in) inside the border of the sterile field: The outer 2.5 cm (1 inch) of the sterile field is considered contaminated. Placing items only 0.5 inches inside this border would place them within the contaminated zone, risking sterile field compromise.

D. Position the bottle outside the edge of the sterile field when pouring solution into a sterile container: While the bottle should not touch the sterile field, it must be close enough to pour without splashing, and the sterile container must be inside the sterile field.